Issues specific to resource-limited settings

There is often a lack of well-trained and experienced research staff to support clinical research. In addition, it is also often difficult for inexperienced researchers to find a mentor, or senior expert who can guide them in specific topics or techniques.

Potential solutions include

Research training programs including degree training, re-entry grants, and career development fellowships. Research networks and working groups also help to strengthen collaboration in research, training, production of analytical reports and build consensus or protocols.

The ISN and ERA-EDTA both offer Fellowships to international applicants from resource poor regions. The American Society of Nephrology provides contact details for US institutions willing to support visiting international fellows. Researchers are encouraged to also investigate fellowships, scholarships or other sources of funding from regional nephrology societies.

• ISN Fellowships
• ASN International Research Scholar Opportunities (note this resource may not be regularly updated)
• Commonwealth Scholarships
• ERA Fellowships and funding

The ISN strongly encourages forming local teams and developing innovative solutions tailored to local context, yet recognises that many under-resourced regions lack adequate infrastructure for research in their hospitals and laboratories. Generally speaking, hospitals are short of basic equipment and resources including lack of necessary communication facilities, electronic filing systems, laboratory equipment.

Potential solutions include

Institutional programme-based support to acquire sustainable research and training capabilities e.g. the sister-renal and transplant center programs of the ISN.

ISN Sister Renal Centers Program

Most universities and institutions do not provide adequate incentives to physicians who are attracted to research. Consequently, researchers usually provide time, energy and money to research in the time left to them outside their clinical work.

Potential solutions include

International, regional and national grants to support priority research and knowledge management activities

In addition, the ISN encourages professionals to engage in advocacy and establish regular communication with local administrators/governments. This may foster local support for addressing kidney diseases by investing in research that is locally relevant and sustainable.

See Funding topic of this toolkit for the possible funding sources.

In some regions, social and cultural factors impact engagement with health systems and with research in particular. It is critically important that local context is taken into account when research is designed. In particular, researchers are encouraged to target their research and communication to local community needs and to consider organized public educational activities to accompany their work or to increase its acceptability.

Some points to consider

1. Cultural differences can be present between those organising or funding the research and the participants.
2. Developing countries may lack a research culture and consequently, little attention is paid to directing resources to conduct research or evaluating a project. Moreover, participants are often unfamiliar with the concept of research and may be sensitive to some practices, such as taking blood samples.
3. In many developing countries, concepts of respect for the family and community are equally as important as, or more important than, the concepts of individual autonomy and rights which underpins Western concepts of research ethics.
4. Weak regulatory frameworks and industry support in developing countries means researchers may have uncertain financial and legal standing.

Many strategies have been proposed for increasing the amount of research in developing countries such as increasing health budget to research, giving local researchers incentives, improving telecommunications and internet access, encouraging twinning programs with a developed country institution and strengthening national research institutions and local research networks. These efforts vary from country to country. Nephrologists with an interst in research are encouraged to become in such activities in their own region.

• The Global Health Network provides an extensive series of resources and links for researchers in low- and middle-income countries.
• The WHO TDR group aims to help researchers in low- and middle-income countries build capacity, provides links to training and fellowships and programs supporting women in scientific research. Their strategic review is also available and highlights some important challenges .
• The Nuffield Council on Bioethics provides an in-depth review of the issues surrounding ethical practice of human research in resource-poor areas.
• The University of Oxford Health Systems Collaborative fosters research capacity in low and middle income countries.
• Field Trials of Health Interventions from International Epidemiological Association\Resources\Publications contains chapters on Community Engagement and Trial Ethics that will be relevant to all resource levels.